Melanoma (cont.)

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What does melanoma look like? What are melanoma symptoms and signs?

Guideline # 3: A changing spot may be a problem, but not every change means cancer. A mole may appear and then get bigger or become raised but still be only a mole. It is normal for many moles to start flat and dark, become raised and dark, and then later lose much of their color. This process takes many years.

Most public-health information about melanoma stresses the so-called ABCDEs:

Asymmetry: One half of the mole is different from the other half.

Border irregularity: The spot has borders which are not smooth and regular but uneven or notched.

Color: The spot has several colors in an irregular pattern or is a very different color than the rest of one's moles.

Diameter: The spot is larger than the size of a pencil eraser (6 mm).

Evolving: The mole is changing in size, shape, color, or overall texture. This may also include new bleeding.

These guidelines are somewhat helpful, but the problem is that many normal moles are not completely symmetrical in their shape or color. This means that many spots, which seem to have one or more of the ABCDEs, are in fact just ordinary moles and not melanomas. Additionally, some melanomas do not fit this description but may still be spotted by a primary-care physician or dermatologist. Not all melanomas have color or are raised on the skin. Amelanotic melanomas have little or no color to the naked eye and may be confused with traumatized benign nevi or basal cell carcinoma. Desmoplastic melanoma may appear to be a thickened area of skin like a scar. These are treated the same way as more typical melanomas but, in the latter case, may be more difficult to determine the exact margins of the tumor.

As a rule, melanoma is not painful unless traumatized. They sometimes itch, but this has no diagnostic or prognostic importance.

What if the skin changes are rapid or dramatic?

Guideline # 4: The more rapid and dramatic the change, the less serious the problem.

When changes such as pain, swelling, or even bleeding come on rapidly, within a day or two, they are likely to be caused by minor trauma, often a kind one doesn't remember (like scratching the spot while sleeping). If a spot changes rapidly and then goes back to the way it was within a couple of weeks, or falls off altogether, it is not likely to represent anything serious. Nevertheless, this would be a good time to say once again: Nobody can diagnose him- or herself. If one sees a spot that looks as though it is new or changing, show it to a doctor. If one see a spot that doesn't look like one's other spots, it should be evaluated.